Functional Coronary Angiography-Derived Index of Microcirculatory Resistance in Patients With ST-Segment Elevation Myocardial Infarction
Ki Hong Choi, Neng Dai, YinLiang Li, Juwon Kim, Doosup Shin, Seung Hun Lee, Hyun Sung Joh, Hyun Kuk Kim, Ki-Hyun Jeon, Sang Jin Ha, Sung-Mok Kim, Mi Ja Jang, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Joon-Hyung Doh, Eun-Seok Shin, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo Myung Lee, Ki Hong Choi, Neng Dai, YinLiang Li, Juwon Kim, Doosup Shin, Seung Hun Lee, Hyun Sung Joh, Hyun Kuk Kim, Ki-Hyun Jeon, Sang Jin Ha, Sung-Mok Kim, Mi Ja Jang, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Joo-Yong Hahn, Joon-Hyung Doh, Eun-Seok Shin, Seung-Hyuk Choi, Hyeon-Cheol Gwon, Joo Myung Lee
Abstract
Objectives: The aim of this study was to evaluate the diagnostic accuracy and prognostic implications of angiography-derived index of microcirculatory resistance (angio-IMR) in patients with ST-segment elevation myocardial infarction (STEMI).
Background: The index of microcirculatory resistance (IMR) is a reliable invasive measure of coronary microvascular dysfunction in patients with STEMI. A functional coronary angiography-derived method to estimate IMR is a wire- and hyperemic agent-free alternative to IMR.
Methods: The study population consisted of 2 independent cohorts. The diagnostic cohort comprised patients with IMR from the culprit vessel immediately after successful primary percutaneous coronary intervention (n = 31). The prognostic cohort was patients with STEMI who were successfully treated with primary percutaneous coronary intervention and followed for 10 years from the index procedure (n = 309). Angio-IMR was calculated using computational flow and pressure simulation. The primary outcome was a composite of cardiac death and readmission for heart failure over 10 years of follow-up.
Results: In the diagnostic cohort, angio-IMR correlated well with IMR (R = 0.778; P < 0.001). Sensitivity, specificity, accuracy, and area under the curve of angio-IMR to predict IMR >40 U were 75.0%, 84.2%, 80.6%, and 0.899 (95% confidence interval: 0.786-0.949), respectively. In the prognostic cohort, patients with angio-IMR >40 U showed significantly higher risk for cardiac death or readmission for heart failure than did those with angio-IMR ≤40 U (46.7% vs 16.6%; adjusted hazard ratio: 2.909; 95% CI: 1.670-5.067; P < 0.001). Angio-IMR >40 U was an independent predictor of cardiac death or readmission for heart failure (hazard ratio: 2.173; 95% CI: 1.157-4.079; P = 0.016) and showed incremental prognostic value compared with a model with clinical risk factors only (C index = 0.726 vs 0.666 [P < 0.001], net reclassification index = 0.704 [P < 0.001]).
Conclusions: Angio-IMR showed high correlation and diagnostic accuracy to predict IMR. Patients with STEMI with angio-IMR >40 U showed a significantly higher risk for cardiac death or readmission for heart failure than those with preserved angio-IMR values. (Prognostic Implication of Angiography-Derived IMR in STEMI Patients; NCT04628377).
Keywords: coronary microcirculation; functional angiography; index of microcirculatory resistance; myocardial infarction; prognosis.
Conflict of interest statement
Funding Support and Author Disclosures This work was supported by Rainmed (which provided the software and console for angio-FFR and angio-IMR). The company had no role in study design or conduct, data analysis, or manuscript preparation. Dr J.M. Lee has received an institutional research grant from St. Jude Medical (Abbott Vascular) and Philips Volcano. Dr Hahn has received an institutional research grant from St. Jude Medical (Abbott Vascular) and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Source: PubMed